Republican Opposition to Obamacare

Monday Wake Up Call – June 11, 2018

The Daily Escape:

Interior, Cuba’s Capitol Building, Havana – 2018 photo by Conor Morrissey

Two things to address on Monday. Take a look inside the program that separates the families of asylum seekers. The WaPo reports that:

A Honduran father separated from his wife and child suffered a breakdown at a Texas jail and killed himself in a padded cell last month, according to Border Patrol agents and an incident report filed by sheriff’s deputies.

The death of 39 year-old Marco Antonio Muñoz, had not been publicly disclosed by the DHS, and did not appear in any local news accounts. Muñoz was found on the floor of his cell May 13 in a pool of blood with an item of clothing twisted around his neck:

According to Border Patrol agents…Muñoz crossed the Rio Grande with his wife and three-year-old son on May 12 near the tiny town of Granjeno, Texas. The area is a popular crossing point for Central American families and teenagers who turn themselves in to apply for asylum in the United States.

Soon after Muñoz and his family were taken into custody, they arrived at a processing station in nearby McAllen and said they wanted to apply for asylum. Border Patrol agents told the family they would be separated. That’s when Muñoz “lost it,” according to one agent…

Unruly detainees are taken to local jails where they can be placed in more secure settings or isolation cells. Border Patrol agents found a vacant cell for Muñoz 40 miles away at the Starr County Jail in Rio Grande City. Muñoz was booked into the jail at 9:40 pm. He remained combative, and was placed in a padded isolation cell. Guards said they checked on Muñoz every 30 minutes, and observed him praying in a corner of his cell the following morning.

A guard who walked by the cell at 9:50 am said he noticed Muñoz laying in the center of the floor, unresponsive and without a pulse. Local sheriff’s deputies recorded the incident as a “suicide in custody.” But the capper is this remark by an ICE agent: (emphasis by Wrongo)

Another agent familiar with what happened said he couldn’t understand why Muñoz “would choose to separate himself from his family forever” by taking his own life.

This asshole’s salary is paid by you and me! It’s time we see these agents for who they really are.

Second, last week the DOJ filed a brief urging a Texas court to invalidate the Affordable Care Act’s crucial insurance reforms, including the prohibition on refusing to cover people with preexisting conditions. In their complaint, states (including Texas and other red states) point out that since Congress has repealed the penalty for going without insurance, the freestanding requirement to get insurance, which is still on the books, is therefore unconstitutional. And because it’s unconstitutional, the courts must invalidate the entire ACA. From the Incidental Economist:

There’s a strong argument to be made in the ACA’s defense. And the Justice Department has had a durable, longstanding, bipartisan commitment to defending the law when non-frivolous arguments can be made in its defense.

If the Justice Department can just throw in the towel whenever a law is challenged in court, it can effectively pick and choose which laws should remain on the books. That’s a flagrant violation of the President’s constitutional duty to take care that the laws are faithfully executed. More:

The President has a duty to take care that all the laws are executed, not just the ones he likes. And while there are cases in which the Justice Department has deviated from that principle, they are extremely rare.

The Trump administration has just announced that it doesn’t care that a law was passed by Congress and signed into law by the President. All that matters is that it hates the law and has a (weak) argument for casting it aside.

Time to wake up America! There is a revolution underway, and we’re being fed the elephant of authoritarianism one little slice at a time. This time, the revolution is televised every day, but we’re not connecting the dots quickly enough.

To help America wake up, here is Iris DeMent with “Living in the Wasteland of the Free”, from her 1996 album, “The Way I Should”:

This song is 22 years old, but still rings true. Iris says: “The poor have now become the enemy” and “Let’s blame our troubles on the weak ones“.

Today, both are true, and are simply sickening.

Those who read the Wrongologist in email can view the video here.

Sunday Cartoon Blogging – March 26, 2017

From the NYT: (brackets by the Wrongologist)

33 Republicans stopped the [Trumpcare] bill. 15 were from the “Freedom Caucus,” 10 were “moderates” mostly from the Northeast (the “Tuesday Group”), some of whose districts went for Clinton, and 8 were miscellaneous (“One said he was concerned about its changes to Medicaid expansion, another preferred a full repeal and a third said he was worried about the bill’s impact on treatment for opioid abuse”).

Republicans control 237 seats of the 435 seats in the House. It requires 218 votes to pass a bill. When Paul Ryan and Donald Trump lost 33 Republican votes, the bill couldn’t pass, and had to be withdrawn. That means the GOP really doesn’t control the House, and that’s unchanged since John Boehner was Speaker.

The Republicans have majority control of the House and the Senate. They also have the self-proclaimed greatest deal-maker sitting in the Oval Office. They have been talking about repealing Obamacare for seven years since it was signed into law, and they couldn’t get their own party to fall in line.

But Trump isn’t a deal maker, he’s a salesman.

And that’s a huge difference. Savvy business people seem willing to buy whatever he is selling. He seems to have the charisma and persuasiveness that in his prior life, made him a top earner as a real estate mogul.

But there’s a difference between making a sale and making a deal. Deal making is hard; you have to build trust, you have to establish real relationships, you need a mastery of your deal points and those of the person on the other side. It can be slow, grinding work.

Trump doesn’t do that, he’s never done that. His entire career is a lurch from one deal to the next, and his Presidency is no different. Trump closed the sale with the American people, but once elected, his job is to make deals.

On to cartoons.

A funny thing happened on the way to the Obamacare execution:

GOP’s Health Care March Madness bracket is now busted:

Boehner shows Ryan how to cope with Freedom Caucus:

Expect the GOP to keep trying to replace Obamacare until we all do this:

Sen. Menendez (D-NJ) burns the GOP:

Sadly, Menendez is also a joke of a Senator. He is about to go on trial for public corruption. Still, the tweet is funny.

Gorsuch epic head-fakes are now a required course in sports:

Trump’s Poodle, Devin Nunes can’t be counted on to keep secrets well, secret:

Sunday Cartoon Blogging – January 8, 2017

Congress returned, and immediately shot itself in the foot by being against ethics before they were for them. That made no sense, even to Overlord Donald I, so Congress backed down. Then Congress got down to business: They revived a rule allowing them to reduce the pay of individual government workers, which was why they were building lists of pro-climate change bureaucrats. Now, they are working on the process for dismantling Obamacare. Dr. Pence nailed the GOP theme:

The GOP will try to baffle the people by guaranteeing “Universal Access”, to health care. That does not ensure that anyone actually has insurance:

The big story of the week was the Russian hacking. Trump was briefed on Friday. Wrongo is skeptical that it made any difference to the election result. Trump’s public skepticism that Russia was behind it is also troubling:

Don’t worry about Trump releasing any secret stuff. The hacking report is 50 pages long, so he’s not reading it. He’ll watch the declassified stuff on Fox News and tweet what he thinks:

The Inauguration is coming. It might look like this:

(This cartoon is by Marian Kamensky, Slovakia)

Once in office, here is Trump’s foreign policy:

(This is from Tom Janssen, The Netherlands)

American Exceptionalism Doesn’t Include Your Healthcare

The Republican’s effort to repeal and (maybe) replace the Affordable Care Act (ACA) began today. From NPR:

Opening punches were thrown in what one top Democrat today called “the first big fight” of the new congressional year – the promise by President-elect Donald Trump and GOP lawmakers to repeal and replace the Affordable Care Act.

The Obamacare debate is political and ideological, and it obscures a hard truth about healthcare in America. Historically, we spend more money than any other country on healthcare.

In the late 1990s, the US spent roughly 13% of its GDP on healthcare, compared to about a 9.5% average for all high income countries. However, the difference has steadily increased. Last year, as the ACA continued to roll out, healthcare costs hit 17.5% of GDP, the highest ever. That’s $9,695 per person.

We spend over $3 trillion on healthcare annually, and that rate of spending is expected to accelerate over the next decade. With all the debate about Obamacare, and what should replace it if it is repealed, we are ignoring what healthcare costs in the US, relative to other high income countries. It may surprise you that America doesn’t have better care than other high income countries, if we compare life expectancy to per capita health expenditures:

Source: Visual Capitalist

Americans spend more money, but do not receive similar results to other countries using the basic metric of life expectancy. Whilst we have fantastic services, like Functional Medicine Clarksville TN for instance, accessibility to these services varies greatly. The chart shows that the divergence started before 1980, and it widens all the way to 2014. While the 2015 statistics are not plotted on this chart, but we know that the healthcare expense in 2015 was 17.5% of GDP, so the divergence is likely to continue to widen.

The conclusion is that while our healthcare spending is considerably higher than in other high income countries, it’s also relatively less effective. If America spent more money and got the same results, we might say that our system is unique, but it produces similar outcomes, so let’s keep it the way it is.

But in fact, Americans on average live shorter lives than people in other high income countries. In fact, life expectancy went down in 2015:

The overall death rate for Americans increased because mortality from heart disease and stroke increased after declining for years. Deaths were also up from Alzheimer’s disease, respiratory disease, kidney disease and diabetes. More Americans also died from unintentional injuries and suicide.

We have a broken political system, one that cannot deal with the root cause of our expensive healthcare, or the fact that our healthcare system simply doesn’t produce the results that others can.

Despite the talk by Republicans about Obamacare being socialized medicine, our system is private, with the exception of the health insurance provided by Medicare and Medicaid. Our insurance companies are private, our physicians (like those at Southwest Care) and providers are private.

By some estimates, the private multi-payer system in the US adds $0.38 for every dollar spent to cover the profits and the discreet management organizations that exist in our multi-payer system. The problem is that there is so much money (over $1 trillion) going to the private players, that they will fight like hell to keep the system as it is.

And they have the lobbying funds available to fight to keep the status quo. Thus, we will continue to deal with excessive costs regardless of no Obamacare, or some jury-rigged GOP Obamacare replacement.

In our Exceptional system, the fact is that even though you pay for health insurance, you are not the actual customer. When you go to the doctor or to the hospital, you are not the actual customer. The Insurance companies are the true customers of the doctors and the hospitals, and for the insurance companies, their shareholders are the true customers.

And before you question the statistics, saying for example, that the US counts infant deaths differently than they do in other countries, the infant death rate in the US is about 0.5% of births, and with about 4 million births in the US that translates into about 20,000 infant deaths. If you remove 20,000 people assigning them a life span of zero, in a country of 320 million people, the overall average life expectancy rises by only 1.81 days (43.4 hours). That is the statistical life span increase assuming we had zero infant deaths. (Please check Wrongo’s math).

Higher infant death rates have virtually no effect on the results shown on the chart.

Remember: Whomever is getting that extra $1 Trillion dollars every year has a trillion reasons why they should keep getting it.

Obamacare: A Success?

Gallup and Healthways 2015 Q2 survey shows that the uninsured rate among US adults aged 18 and older was 11.4% in the second quarter of 2015, down from 11.9% in the first quarter. The uninsured rate has dropped nearly six percentage points since the fourth quarter of 2013, just before the requirement for Americans to carry health insurance took effect. The latest quarterly uninsured rate is the lowest Gallup and Healthways have recorded since daily tracking of this metric began in 2008. The recent Supreme Court ruling in King v. Burwell affirmed the legality of subsidies provided to those obtaining insurance through the Affordable Care Act via a federal or state exchange. Here are Gallup’s findings:

So, a byzantine insurance scheme originally designed by the Heritage Foundation as a way to keep the insurance cartel from suffering too much, now looks like a success, if reducing the numbers of the uninsured was the goal. But, once it went into effect, it became collectivism to Republicans, with the label “Obamacare” as if it had sprung fully formed from the mind of a Kenyan Socialist.

Here is a second data point, the use of subsidies by ACA insured by state:

Why Bloomberg thinks Massachusetts is a red state is unexplainable, despite the fact that it has a Republican governor. But, it does serve to lower the red state average a bit. Poor states use more subsidies. Not exactly a surprise:

• These are the states where workers regularly vote against unions, even when it means job losses as in the case of Volkswagen in Tennessee.
• Where else but in a red state could the US manager of the new Mercedes plant be arrested at a traffic stop as a potential illegal immigrant?
• Where else would they fly a rebel flag 150 years after surrender? Many of these same states also get large federal agricultural subsidies, but that is acceptable, because the subsidies mainly go to wealthy individuals and corporations.

But, almost half of Americans still oppose Obamacare. Failure was inevitable, success inconceivable, and therefore failure must have happened.

Now there is an agreement in principle to the Greek debt crisis after all. Here, as explained in terms of Grease the musical, is your cliff notes version of the situation. You will not be disappointed if you watch:

For those who read the Wrongologist in email, you can view the video here.

Moving the Goal Posts on Obamacare

Gallup has an informative chart about the declining percentage of uninsured in the US:

The percentage of uninsured Americans climbed from the mid-14% range in early 2008 and peaked at 18.0% in the third quarter of 2013. The uninsured rate has dropped sharply since Obamacare (the Affordable Care Act) took effect at the beginning of 2014.

It is possible to argue that an improving economy and a falling unemployment rate may have accelerated the steep drop in the percentage of uninsured over the past year. However, the uninsured rate is significantly lower than it was in early 2008, before the Great Recession, suggesting that the recent decline is due more to Obamacare than to just an improving economy.

From NY Magazine on this trend:

It is starting to look possible that this trend is not some random fluke that has happened six straight quarters but is somehow related to the enactment of Obamacare. So any day now, we can expect conservative politicians and intellectuals to begin publicly rethinking their analysis of this law.

They were correct. Here is the 2010-2014 short version of the Republican viewpoint on the ACA:

The ACA will not reduce the number of people without health insurance. Indeed, it might make this problem we don’t consider a problem, even worse.

Now that the ACA looks to be doing the job, the 2015 short version of the Republican viewpoint is:

Everyone knew that the ACA would result in a huge drop in the number of people without health insurance — what does that prove? Besides, how can we really know that it all isn’t a big coincidence?

This is called “Moving the Goal Posts”. Wikipedia says it means

To change the criterion (goal) of a process or competition while still in progress, in such a way that the new goal offers one side an intentional advantage or disadvantage.

Here is an example of moving the goal posts. From Cliff Asness: (emphasis by the Wrongologist)

In contrast, the rise in coverage is heralded by a myriad of Obamacare supporters as one of two major pieces of proof the law is working. But, how can something we knew before the fact be proof of anything?

Shorter: If we predict that something good will happen as a result of a new law, and that good thing happens, it doesn’t count as proof that the law served its purpose or was any good at all, unless Republicans say so.

The goal post movers also said Obamacare was a job killer. House Speaker John Boehner announced on March 17, 2010, five days before President Obama signed the ACA into law:

The President … continues to push his job-killing government takeover of health care that will hurt small businesses at a time when they need certainty, not more Washington tax hikes and mandates.

In 2011, House Republicans even passed the “Repealing the Job-Killing Health Care Law Act” — the first time that any piece of congressional legislation ever had “job-killing” in its title. Sadly for both Mr. Boehner and the House Republicans, we have added 12 million new private sector jobs since the bill was passed.

There is a new J.D. Power survey which looks at enrollee satisfaction with the ACA. It finds that people who signed up for insurance on the exchanges were slightly more satisfied (69.6%) than people with non-exchange plans, usually through employers (67.9%). People re-enrolling on the exchanges were 74.4% satisfied. New enrollees for 2015 were 5.5% more satisfied than 2014 enrollees, who endured the disastrous roll-out of healthcare.gov. So people like the subsidies and they like their actual insurance policies.

Think about it: ACA forecasted costs have been consistently revised downwards. The number of uninsured are dramatically lower. Satisfaction with Obamacare is higher, and it didn’t kill jobs.

It’s utter Tyranny.

Maybe that’s why the Senate’s top five Republican leaders have cosponsored legislation to extend Obamacare insurance subsidies until 2017. The extension will give Republicans more time to again move the goal posts.

They should try this one: Now that Republicans control Congress and most state governments, we have way fewer uninsured.

Conservative policies work!

The Wrongologist

Geopolitics, Power and Political Economy

Tag: Republican Opposition to Obamacare